scholarly journals P1459 Flu-like syndrome complicated in a rare form of infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Kristo ◽  
J Nacher Jimenez ◽  
J Moya Nur ◽  
J Roda ◽  
B Seidelberger ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Blood Culture ◽  
Ct Scan ◽  
Healthy Woman ◽  
Clinical Severity ◽  
Posterior Leaflet ◽  
Haemophilus Parainfluenzae ◽  
History Of ◽  
The Right

Abstract Background The HACEK group of organisms are one of the infrequent causes of infective endocarditis (IE)(5% of cases in adults).Cultures require long incubation time and clinical presentation may be insidious,delaying final diagnosis.We report a case of subacute atypical presentation of native mitral valve Haemophilus parainfluenzae IE A 33 yo female with no history of cardiac disease was presented in our hospital with malaise,weakness &high fever till 39oC for at about two weeks.The patient was treated with levofloxacin and discharged. The 1st blood culture was negative.After 25 days the patient was presented with prolonged fever,neurological signs of TIA(motor aphasia and septic embolic episode of 2nd level on the right hand&foot).Physical exam normal,no cardiac murmurs. ECG:normal. Echo:TTE-mitral valve with thickened leaflet, presence of structures suggestive for vegetations (15x19 mm) at the posterior leaflet, perforation of the posterior leaflet causing an IM mild-moderate.TEE-mitral valve with small posterior leaflet, big anterior leaflet with mobile vegetations of coral-forms with diameter maximum 20x10 mm,located at A3 scallop of mitral valve at posteromedial commissural,with a perforation at this level causing moderate IM.No other pathological findings.Cranial CT scan-no data of any acute intracranial abnormality.Body CT scan-a low uptake area of the renal parenchyma related to acute pyelonephritis/infarction.Blood tests-elevated CRP & thrombocytopenia.Blood culture(2nd one): Haemophilus parainfluenzae.Treatment-The patient went on ceftriaxone and underwent a surgical mitral valve repair with mitral annuloplasty and patch placement because of the size of the vegetation and the embolic risk.We also respect the desire of the patient to be pregnant.The patient improved, no fever. Follow-up:CRP normal.TTE echo showed no evidence of the previously detected vegetation with a residual mild MR.The patient was discharged home followed up after 6 weeks with full recovery. Discussion We present the case of a young healthy woman without any diseases,admitted with the symptoms of a simple flu-like syndrome with a negative blood culture, but complicated later in one of the rarest forms of IE with Haemophilus parainfluenzae. HACEK organisms are most often associated with IE, although rare, can be extremely serious because of the tendency of big size vegetation and embolic episodes,but outcomes generally are successful if the organism is identified early and treated appropriately.The treatment of a HACEK infection is based on the location of the infection,clinical severity and available susceptibility data.According to the ESC recommendations Ceftriaxone or ampicillin/sulbactam is the therapy of choice for patients with HACEK endocarditis in both native and prosthetic-valve endocarditis.Fluoroquinolones may be considered as alternative therapy.Regardless of the agent chosen,treatment should last 4– 6 weeks,depending upon the type of valve involved Abstract P1459 Figure.

Can Infectious Endocarditis during Pregnancy Be Cured with Only Drug Treatment?

2015 ◽  
Vol 18 (1) ◽  
pp. 033
Author(s):  
Serhat Caliskan ◽  
Feyzullah Besli ◽  
Saim Sag ◽  
Fatih Gungoren ◽  
Ibrahim Baran
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Treatment Options ◽  
Blood Cultures ◽  
Normal Vaginal Delivery ◽  
Posterior Leaflet ◽  
History Of ◽  
Current Guidelines

During pregnancy, infective endocarditis (IE) is quite rare but has a high mortality rate in terms of the mother and the fetus. In this article, a 24-year-old patient with a history of mitral valve prolapse (MVP) who was hospitalized due to IE and treated successfully is presented. On echocardiography, severe mitral valve prolapse, severe mitral regurgitation, and vegetation on the posterior leaflet of mitral valve were observed. Streptococcus mitis was subsequently isolated from four sets of blood cultures. The patient was diagnosed with IE. After 6 weeks of antibiotic therapy, the patient was cured completely without surgical treatment. At 40-weeks of pregnancy, the patient gave birth via a normal vaginal delivery. There were no problems with the 3,800-gram baby born. In current guidelines, there is very limited advice on treatment options for patients who develop IE during pregnancy. Therefore, evaluation of patient-based treatment options would be appropriate. In addition, IE prophylaxis for MVP is not recommended in current guidelines. However, in MVP patients with mitral regurgitation, prior to procedures associated with a high risk of infective endocarditis, IE prophylaxis may be rational.

scholarly journals Resection of a colonic mass following trauma: a diagnostic dilemma

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Paul Burchard ◽  
Alan A Thomay
Keyword(s):  
Ct Scan ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Symptomatic Improvement ◽  
Diagnostic Dilemma ◽  
Vehicle Accident ◽  
Abdomen Ct ◽  
History Of ◽  
Mitotic Figures ◽  
The Right

Abstract A 53-year-old Caucasian male presented with a 2-week history of abdominal distension, pain, nausea and lethargy. His symptoms began 1 day after an all-terrain vehicle accident during which he suffered blunt-force trauma to his mid-right abdomen. CT scan demonstrated abnormal thickening of the ascending colon and terminal ilium with surrounding inflammation within the retroperitoneum and colonic mesentery. Given his likely mechanism and symptomatic improvement, he was initially managed conservatively. However, he was readmitted with recurrence of symptoms, and a repeat CT scan demonstrated no interval improvement. An exploratory laparotomy was performed and a firm, fixed mass of the right-colon and colonic mesentery was found. Final histopathology of the mass revealed a diffuse lymphoid infiltrate with numerous mitotic figures and apoptotic cells. Immunohistochemical staining was positive for CD45, CD20, CD10, and BCL-6 and negative for CD3, TdT, and BCL-2, indicating a diagnosis of Burkitt lymphoma.

scholarly journals Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Heerani Woodun ◽  
Sarah Bouayyad ◽  
Sura Sahib ◽  
Nadir Elamin ◽  
Steven Hunter ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Intravenous Drug User ◽  
Blood Cultures ◽  
Topical Steroids ◽  
Foramen Ovale ◽  
History Of ◽  
The Right ◽  
Systemic Infections

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

scholarly journals Is the Recurrence of Fibroma of the Tendon Sheath Underestimated? An Instructive Case Report and a Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
E. Lüdke ◽  
G. Kohut ◽  
H. C. Bäcker ◽  
M. Maniglio
Keyword(s):  
Scientific Literature ◽  
Healthy Woman ◽  
Tendon Sheath ◽  
Gadolinium Enhancement ◽  
Complete Excision ◽  
History Of ◽  
Initial Outcome ◽  
The Right ◽  
Instructive Case

We report a case of a 21-year-old healthy woman with a history of a painful growing mass in the palm of the right hand, with a trigger finger phenomenon. The mass was surgically entirely excised, and the histological findings of the tumor were those of a fibroma of the tendon sheath (FTS) starting from the flexor tendons. Although the initial outcome was good, the patient experienced the same symptoms at the same location 4.5 years later. The MRI demonstrated a 50×10×5 mm mass of low intensity on T1-weighted images and high intensity on T2-weighted images and gadolinium enhancement. A second complete excision of the tumor was performed by the same senior surgeon, and the histology confirmed the recurrence of the FTS. We also reviewed the scientific literature about FTS in the hand. Most recent studies show a low rate or no recurrence at all. We hypothesize that a lot of recurrences are missed because of a short follow-up and that the recurrence rate may be higher than thought.

Streptococcus gordonii-associated infective endocarditis in a girl with Barlow’s mitral valve disease

2019 ◽  
Vol 29 (8) ◽  
pp. 1099-1100
Author(s):  
Roman R. Komorovsky ◽  
Oksana R. Boyarchuk ◽  
Vira O. Synytska
Keyword(s):  
Differential Diagnosis ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Mitral Valve Disease ◽  
Valve Disease ◽  
Streptococcus Gordonii ◽  
Rheumatic Carditis

AbstractWe present a case of infective endocarditis caused by Streptococcus gordonii in an 11-year-old girl with Barlow’s mitral valve disease. The differential diagnosis of rheumatic carditis and infective endocarditis was difficult as the patient fulfilled the Jones criteria. Vegetation on the mitral valve which became evident later in course of the disease and positive blood culture allowed diagnosing “definite” infective endocarditis.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

scholarly journals Infective Endocarditis by Pseudomonas Species Following Percutaneous Transluminal Mitral Commissurotomy

1970 ◽  
Vol 2 (2) ◽  
pp. 252-255
Author(s):  
MT Rahman ◽  
MA Mannan ◽  
M Ullah ◽  
Z Rahman ◽  
A Khair ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Blood Culture ◽  
Anterior Leaflet ◽  
Pseudomonas Species ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Mitral Commissurotomy ◽  
Percutaneous Transluminal ◽  
Percutaneous Transluminal Mitral Commissurotomy

Infective mitral valve endocarditis developed in a 35-year-old male patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated vegetation in the anterior leaflet of the mitral valve and blood culture showed growth of Pseudomonas species which was sensitive to Ceftazidime, Ciprofloxacin, Cotrimoxazole and Imipenem and resistant to Amikacin, Ceftriaxone, Gentamycin and Nitilmycin. The patient underwent treatment with intravenous ceftazidime and ciprofloxacin for six weeks and patient improved significantly and got cure of the disease. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of antibiotics and operation are discussed. Keywords: PTMC; Infective endocarditis. DOI: 10.3329/cardio.v2i2.6649Cardiovasc. j. 2010; 2(2) : 252-255

scholarly journals Perforated Mitral Valve Aneurysm in the Posterior Leaflet without Infective Endocarditis

2012 ◽  
Vol 20 (2) ◽  
pp. 100 ◽  
Author(s):  
Dong-Jun Kim ◽  
Kyoung-Im Cho ◽  
Hee-Jae Jun ◽  
You-Jeong Kim ◽  
Yeo-Jeong Song ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Posterior Leaflet

scholarly journals P1702 Libman-Sacks endocarditis of the mitral valve combined with right atrial thrombus formation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Klappacher ◽  
D Beitzke
Keyword(s):  
Mitral Valve ◽  
Thrombus Formation ◽  
Arterial System ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Systemic Embolization ◽  
History Of ◽  
Right Atrial Thrombus ◽  
The Right ◽  
The Brain

Abstract Case presentation A 46-years old female with a history of systemic lupus erythematosus (SLE) was admitted to hospital care after the manifestation of a tonic-clonic generalized seizure. Since this had been the first neurological event, a thorough diagnostic work-up was performed. CT- and MRI-imaging of the brain revealed cerebral microangiopathy and two small fresh ischemic lesions in the left frontal and temporobasal regions, respectively. While the microangiopathy could be reconciled with cerebral SLE-vasculitis, the ischemic lesions pointed to thromboembolism whose source could be potentially cardiogenic. Findings. In fact, the transesophageal echocardiogram showed a small vegetation (5x8 mm) on the posteromedial cusp of the posterior mitral leaflet (P3) with moderate regurgitation, likely to represent Libman-Sacks endocarditis and a potential source of systemic embolization. In addition, a mass of was visible protruding from the fossa ovalis into the right atrium, see figure. It represented a thrombus according to MRI which was subsequently performed. Since no interatrial passage of microbubbles occurred, the foramen ovale was unlikely to be patent and to allow for paradoxical embolism into the brain. However, the right atrial thrombus was compatible with a history of repeated deep venous thrombosis and pulmonary embolism in the recent past. Discussion This case exemplifies the combination of Libman-Sacks endocarditis on the mitral valve with right atrial thrombus formation and ensuing embolism both into the venous and arterial system. It demonstrates the importance of closely monitoring and treating coagulopathies in SLE patients which makes them prone to thrombus formation both in the systemic and pulmonary circulation. Abstract P1702 Figure.

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